The contents of this website are for contemplative purposes only. No medical advice will be given, and emails asking for medical advice will be ignored.

Although patient vignettes are based on my experiences with real individuals, I liberally change details to maintain patient confidentiality.

I also reserve the right to change old postings to correct errors, and to delete comments that include obscene language or that I deem abusive to me or other commentators. If you are looking for a open mind, I suggest you consult a neurosurgeon.

I’ll admit I suffered a twinge of liberal guilt when I bought my last car in November. I went for an Infiniti G35, one of Infiniti’s low-end models but hardly anything to be ashamed about. Moon roof, 280 horsepower, standard leather interior. Its drawback is relatively poor gas mileage – about 18 in the city. My last car was an Infiniti, and after I bought it I promised myself my next vehicle would be a greener model. Maybe one of those hybrid jobs.

Hurricane Katrina threw me off of this plan, as she has off of so many others. She killed my old G35 in its infancy, after only 15,000 miles and 18 months of service. I knew when I left it behind I would never see it again. But I was afraid to evacuate New Orleans with my family in two cars – we might get separated in the traffic – and the other car was larger and could carry more stuff. That is another story.

When I came back after the storm and verified that my poor car had taken on 12 feet of water, I reacted like someone who just lost a beloved pet. I had to have another one, just like the last. The green promise went out the window. Oh, I tried. I thumbed through many a car guide. I even subscribed to the on-line Consumer Reports new car guide and ran every model I could think of against the G35. Had to have it. It was more a matter of putting things back the way they were, than any consideration about what was the best car. So I bought it, and screw the environment.

Lucky for me, my petty liberal guilt was assuaged by a column in the Wall Street Journallast week. In speaking about so-called “green” houses, the author, architectural critic David Akst, pointed out quite acerbically that green is relative. He noted that most green homes are single-family dwellings with high square footage. What is green about a 15,000 square foot house, he asks, even if it is solar heated? You still have to chop down and process trees, chemically treat wood, manufacture paint and plastic to build a house. The bigger the house, the more natural resources have to be consumed.

Green is small, a mobile home, for instance. No one with the resources to build green builds modest. Green houses are usually ostentations mansions, and thus a waste of building materials. A real green building is a tenement with 600 square foot apartments, or a house with 3 families living in it. Efficiency makes something green, and efficiency does not mean solar power. It means people living modestly, in close quarters.

Akst makes the point that people who design and live in green houses often make lifestyle choices that negate the benefits of the houses. For instance, a green home that is a 2-hour commute from work is hardly green, is it? Even if the owner buys a hybrid car that gets 60 miles per gallon, the wear-and-tear of the commute uses up the car, meaning more frequent oil changes, battery changes, new tires, and in the end, a new car at an earlier date.

Which brings me to my green gas guzzler. I live in a small country town, and my office is literally next to a cow pasture. My house is 7 miles from my office, and I can make the drive in 9 minutes flat. I fill up my tank once every 3 weeks. Who is greener, I in the country gas guzzler or the Los Angelino who lives 25 miles from work, takes 70 minutes to get there, and owns a hybrid but still has to refill the tank every weekend? Even if he carpools, the Angelino will have a devil of a time keeping up with me. And if I turn off my air conditioner and open my moon roof, well, he’s whipped.

So I am green after all. Not green because my car gets low mileage, but green because I have made a lifestyle choice that permits me to use less non-renewable resources. Green is not about what you choose to buy. That is mindless, consumerist thinking. Green is about how you choose to live.

By now people nationwide are familiar with New Orleans Mayor Ray Nagin's comments on Martin Luther King Day. For those who haven’t heard, I’ll summarize. Nagin got in trouble for two separate comments. First, he said that Hurricane Katrina hit New Orleans because “God is angry with us.” Second, he said that New Orleans was a “chocolate city” before the storm, and would be a “chocolate city” again.

The “chocolate city” remark probably has gotten the most mileage, because it is the easiest to ridicule. Referring to black people as “chocolate” is in some circles mildly demeaning, and in others is used endearingly. Sometimes it has sexual overtones, as in “I’m gonna get me some chocolate tonight.” Either way, it was an oddball way to open a political address. I doubt Nagin meant anything by it. I think it was just an attempt at humor. All politicians need to attend a comedy workshop, where they can learn the golden rule of comedy – LEAVE IT TO THE PROFESSIONALS. If you don’t know how to be funny, don’t try. There is no easier way to look stupid than to make ill-timed stabs at humor.

As for the “God is mad at us” argument, this is really peculiar. More than one religious conservative has taken his licks from the media for issuing the old the-victims-must-have-deserved-it argument. For him to have touched this tar baby seems colossally stupid. What was he thinking?

I happened to hear part of Nagin’s speech live on the radio, so I can tell you what he was thinking. He was trying to pull of an imitation of Martin Luther King. His speaking style and vocal intonations were straight from the pulpit. He even went into a long and sometimes confusing reverie about seeing Dr. King in a dream and asking him his opinion on how things were going here on earth. It was hard to tell sometimes if Nagin was talking, or if he was paraphrasing the advise of his imaginary Dr. King. And of course that is leaving aside the question of if Ray Nagin would even know what King would say if he were alive. Does he really know?

Nagin is a businessman by trade. Martin Luther King was a Baptist minister, and one of the best orators this country has ever seen. Nagin would have had an easier time strapping on a pair of Nikes and imitating a Michael Jordan highlight reel than trying to approach King’s speaking style. I still get chills every time I hear the “I Have A Dream” speech, and I have heard it hundreds of times.

In trying to imitate King, Nagin drove himself into a difficult situation. He tried to weave King’s powerful sense of faith in God and divine morality into his words. Dr. King’s speeches were all about morality, and faith, and purpose, and he did it better than just about anybody. Mr. Anybody Politician can’t just put that mantle on like a Santa Claus suit and prance around for everyone’s pleasure. King got shot for saying what he said. If you are going to imitate the Reverend, you had better be sure of yourself.

Nagin was just fooling around. He was doing an imitation for a mostly black crowd, a supportive crowd, and he was trying to make them feel good. He was telling them what they wanted to hear. But Martin Luther King never told people what they wanted to hear. He told them what they needed to hear, and the heck with the consequences.

Ray Nagin is not an articulate man. He dresses sharp, looks good, appears bright and educated, but when he opens his mouth the words come stumbling out like drunks out a Bourbon Street bar after last call. In a way, he reminds me of George W. Bush, who also looks like he should be articulate but isn’t. W has one huge advantage over Nagin – he has advisors who tell him what not to say.

If Nagin wants to study great oratory (and who doesn’t!), I refer him to Harry S Truman. Truman was not a great writer or orator, but he was effective because he knew his limits and spoke plainly and honestly. Truman rarely put on airs. He played himself, and had a very successful run doing it.

I kept it in my right desk drawer. Frequently overlaid with misplaced papers, unwanted drug samples, and forlorn drug-rep paraphernalia was the worst gift I ever got. My desk and my office took on 8 feet of water after Hurricane Katrina, so I only have my memory of it; but my memory in this rare case is perfect: It was a 5-inch tall gray ceramic skull, a Halloween trinket, glazed to a high gloss. It had amber plastic orbits and a divot near the apex, right at the sagittal suture, for the insertion of a candle. It was, in a word, tacky. I kept it to remind me that I could never get a worse gift. My little Yorick humored me.

As with any gift, its value was derived not simply from the value of the object itself but also from the circumstances of the giving, which I will now relate.

I had a patient, whom I will call Charley, that visited me from time to time for his diabetes. Charley would call my office to make an appointment for refills on his insulin almost every month, which tipped me off already of a scam in progress because I never failed to write him less than 3 refills for that medication. He would amble into the office, and when the door closed, the real reason for his visit would slowly emerge. Vicodin. The love of his life since his wife left him. Charley was very overweight and not well acquainted with bathtubs. Though he was always polite and respectful, it goes without saying that we did not always come to a mutual understanding about his pain needs.

Charley claimed disability from back pain, but, like many disabled patients in my old neighborhood, he sometimes worked side jobs to make ends meet. I did not necessarily hold this against him, since disability in Louisiana rarely pays more than $500 a month, a small sum that would scarcely cover my grocery bill, let alone his.

When Charley gave me the gift of the ceramic skull, he told me he got it for my kids, and that he stole it. Told me straight faced like he was supposed to do it. He had taken a job unloading trucks at the Dollar Store, a job he admitted he was paid "under the table" for. At the end of the work day he just slipped a couple of these fine items into the trunk of his car for gifts to family and friends.

Perhaps I should have been touched by his generosity. In a way I guess I was, but when I began to tally the value of the gift in my mind, the negatives ran so great in relation to its value that I clearly discerned that pound for pound, this was the crummiest gift I had ever gotten. First, it was a piece of junk -- it came from the Dollar Store, which pretty much told me what it was worth. Second, it was stolen. Third, it was stolen on the job by an employee who was working illegally (no taxes paid) and against the terms of his disability agreement, which requires that the recipient does not work. Fourth, he was unloading trucks at this illicit job, which told me that he was less disabled than he was letting on. Fifth, he intended for me to pass this stolen gift on to my children. And last, and not at all least, I knew he was giving me that gift to butter me up for future Vicodin requests.

I wonder if a police officer was ever offered a 25 cent bribe? Or if an individual ever tried to claim a tax deduction on shoplifted clothing donated to the Salvation Army?

Needless to say, this choice bauble and I were not to be separated. It was my first non-drug rep bribe! So it sat in my drawer, and sat and sat, and from time to time I would dig it out and behold the new low in the world of pathetic gifts. I would laugh and put it back. It remained in its particle board sarcophagus until the flood waters of Katrina came and took it away. Alas, I miss poor Yorick!

National Public Radio had a luminous story this morning about the Bordelons, a family trying to rebuild in my old neighborhood, St. Bernard Parish. This was my first time hearing them, but apparently NPR has been following their story for quite some time now, and they seem to be very popular.

With good reason. The Bordelons reminded me, after much recent bad press about New Orleans, why I love the city so much. Despite losing everything in the hurricane, the Bordelons continue to be upbeat and happy. They waited months for a FEMA trailer, only to turn it over to relatives as soon as it arrived because the relatives had no place to live. They continue to live on the second floor of the house (the bottom floor is stripped to the studs because of flood water damage), with no electricity, and are simply happy with what little they have. There is no self-pity. Just an unshakable belief that as long as life goes on, there will always be an opportunity to pass a good time.*

And they sum New Orleans up. New Orleans and all South Louisiana have always had a certain devil-may-care attitude towards life, partially reflected in the well known Cajun phrase, "Laissez les bon temps rouler" ("Let the good times roll"). This attitude is very frustrating when issues of social reform come up, but is absolutely wonderful when times get tough. The Bordelons are not unique; they are typical of people I have known all my life.

It may not be possible for me to live in New Orleans all my life, but I certainly want to die there.

Note: In the interest of being picayune, I will point out that NPR makes an error in referring to the Bordelon's home as St. Bernard's. It is correctly called St. Bernard Parish.